Diabetic nephropathy/diabetic kidney disease

Summary

Diabetic kidney disease (DKD), which belongs to the triad of diabetic microvascular complications, is currently the main cause of end–stage renal disease in developed countries. DKD usually simultaneously leads to a deteriorated long–term control of glucose metabolism and blood pressure, and to the development of diabetic retinopathy, neuropathy and atherosclerotic complications, which are the main causes of patients’ mortality. Screening of the initial stages of DKD is to be based on the detection of increased albumin leak into the urine, microalbuminuria, and the reduction of renal function by means of estimates of glomerular filtration rate based on the serum creatinine level. The main objective of the prophylactic and treatment measures is to prevent the onset of DKD, or at least to stop its transition into an irreversible, progressive stage characterised by a permanent, often nephrotic proteinuria. The basic procedures in the prevention and treatment of DKD are maintaining the optimal metabolic control of diabetes and intensive hypertension treatment based on the inhibition of the renin–angiotensin system. Reaching the stage of progressive renal insufficiency (serum creatinine level approximately ≥ 200µmol/l) is an indication for further follow–up in the nephrology department, which will then take the necessary preparatory measures for dialysis treatment. The optimal method of kidney function replacement for patients with DKD is kidney transplantation, or combined kidney–pancreas transplantation in patients with type 1 diabetes.

Key words:
diabetic kidney disease – microalbuminuria – glomerular filtration – proteinuria – chronic kidney failure – kidney transplantation – combined kidney–pancreas transplantation